Getting help for the mentally ill

Mark S. Komrad

Though none of us yet knows much of Adam Lanza's backstory, it doesn't take a mental health professional to suspect that a man who killed his mother before killing so many children and adults was likely suffering from a severe mental disorder. Although mental illness very rarely results in violence, let alone such heinous behavior, the fact is that so many of those who could benefit from state-of-the-art treatment do not receive it, for a variety of reasons. For example, some fear the implications of facing a condition that might limit the power of will to control thoughts, feelings or behaviors. Some are intimidated by the stigma of mental illness. Or, as with other medical conditions, financial limitations might make treatment difficult to obtain.

However, the possibility of preventing the rare violence that comes from mental illness starts with getting people in the door of treatment first. That can be the hardest part. I have spent 25 years as a psychiatrist brainstorming with people who consult me about how to get a loved one into treatment. It is close family and friends who are often in the best position to urge a troubled person to get professional help. Yet that opportunity is commonly missed. We can feel that it is impolite or insulting to approach this awkward topic. We are too easily put off or intimidated by the resistance and rejection we may encounter (e.g., "I'm not crazy!"). We give up far too easily.

Persuading a loved one to get needed treatment may take more than one approach. It might start with delicately and strategically discussing your own pain that the troubled person may be causing and your sense of helplessness in the face of his behavior or mood. This effort to persuade requires overcoming the fear of being rebuffed and bravely persisting in the message.

Many people have succeeded in creative ways, like the woman who asked her husband for a unique Christmas gift. She told him, "There is a gift I want that would be more precious to me than anything you could buy in a store: your seeing a psychiatrist — just one time — to talk about your depression. I only want to know if it's possible for you to feel better." It worked. He gave her the gift she wanted and was persuaded at that appointment to give treatment a try.

Serious conversations need to be pursued at the right time, a special time: not in a sudden, aggressive way; not when the troubled other is drinking; not at family gatherings when people want to appear at their best. If private and personal conversations are not fruitful, you might need to call on key allies for help, such as the person's primary care provider, clergy, coach or influential family members.

The problems may appear dire enough that it becomes necessary to push harder, using the power of your relationship. In counseling families about a troubled relative who has been refusing to get needed help, I have found that the greatest resource is often untapped: the power of family to steer, even to coerce, family members toward entering treatment. Sometimes the situation becomes more acute and dire. Perhaps the person is threatening suicide, or has said or written things that sound like he is contemplating violence, or she has behaved in overtly violent ways that seem to be caused by emotional illness of some sort. Then, systems to mobilize psychiatric evaluation on an involuntary basis are available. The police can explain the procedures if you call.

When you see someone in emotional trouble that goes beyond the ability of your attention and kindness to help, when you feel that more professional expertise is needed, do not remain silent. Do not avoid the subject, or let it go for fear that you might be meddling. Alone, or with the help of others, you need to say to him or her: "You need help."

Dr. Mark S. Komrad, a psychiatrist on the teaching faculty of Sheppard Pratt and Johns Hopkins hospitals, is the author of "You Need Help: A Step-by-Step Guide to Convince a Loved One to Get Counseling." Website: www.youneedhelpbook.com